Insulin

Question 1

How can the insulin be stimulated?

Answer 1

1. High blood glocose
2. GI hormone ( e.g. gastrin, cholecstokinin, gastric inhibitory peptide/ GIP, glucagon like peptite/GLP)
3. OTHER stimuli, ( amino acid, fatty acid, the parasympathetic nervous system)
4. Beta sympathetic nervous system

Question 2

How do insulin be excreted from body ?

Answer 2

1 liver <60%>
2. Kidney 35-40%

Question 3

The action of insulin:

Answer 3

1. Increase insulin uptake for utilisation( glycolysis)
2. Glycogen synthesis (glucose to glycogen in liver)
   3 . Protein synthesis
3. Lipogenesis
4. Inhibit glycogenolysis (glycogen–> glucose) and glyconeogenesis
5. Decrease proteim breakdown and inhibit oxidation of amino acids in the livee
6. Transport into cells of K, Ca, necleosides and inorganic phosphate

Question 4

Metformin, actions include:

Answer 4

1. Increase insulin sensitivity
2. Direct stimulation of glycolysis in tissues, with increased glucose removal from blood
3. Reduce hepatic and renal gluconeogenesis
4. Slowing the glucose absorptiom from the GIT
5. Reduction of plasma glucagon levels

Targeting the fasting glucose with high efficacy

Question 5

Properties of metformin

Answer 5

1. Not bound to plasma protein
2. Not metabolism
3. Is excreted by the kidneys as the active compound

Question 6

What are the aderse effects of metformin?

Answer 6

1. Anorexia ( LOA), N/V, abdominal distension and diarrhoea ( to take with food, GI S/E may improve after 1 to 2 mths of treatment
2. Reduced absorption of Vit B12
3. May need to monitor Cr ( high Cr may leads to metformin build up in the body, leading to metfamin acidosis)

Question 7

Metformin is contraindicated for:

Answer 7

1. Renal disease
2. Alcoholism
3. Hepatic disease
4. Or conditions predisposing to tissue anoxia

Question 8

MOA of sulfonylurea:

Answer 8

sulphonylurea receptor coassembles with the Kir subunit in a 4:4 steichiometry to form an actameric channel complex.
This complex forms the ATP-sensitive K+ (Katp] channel.
Both subunits must be coexpressed to obtain functional channel activity.

Action:
1. Increase insulim release from Pancreatic B cells
2. Reduction of serum glucogon concentrations

Question 9

S/e of sulfonylureas

Answer 9

1. Hypoglycemia
2. Weight gain
3. GI upset
4. Allergic skin rashes, bone marrow damage
5. Increase in cardiovascular death